Clinical Endoscopy

Original Articles

Endoscopic resection of gastric gastrointestinal stromal tumor using clip-and-cut endoscopic full-thickness resection: a single-center, retrospective cohort in Korea: Yuri Kim, Ji Yong Ahn, Hwoon-Yong Jung, Seokin Kang, Ho June Song, Kee Don Choi, Do Hoon Kim, Jeong Hoon Lee, Hee Kyong Na, Young Soo Park; Clin Endosc 2024;57(3):350-363. Published online February 15, 2024; DOI: https://doi.org/10.5946/ce.2023.144

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Background
/Aims: To overcome the technical limitations of classic endoscopic resection for gastric gastrointestinal stromal tumors (GISTs), various methods have been developed. In this study, we examined the role and feasibility of clip-and-cut procedures (clip-and-cut endoscopic full-thickness resection [cc-EFTR]) for gastric GISTs.
Methods
Medical records of 83 patients diagnosed with GISTs after endoscopic resection between 2005 and 2021 were retrospectively reviewed. Moreover, clinical characteristics and outcomes were analyzed.
Results
Endoscopic submucosal dissection (ESD) and cc-EFTR were performed in 51 and 32 patients, respectively. The GISTs were detected in the upper third of the stomach for ESD (52.9%) and cc-EFTR (90.6%). Within the cc-EFTR group, a majority of GISTs were located in the deep muscularis propria or serosal layer, accounting for 96.9%, as opposed to those in the ESD group (45.1%). The R0 resection rates were 51.0% and 84.4% in the ESD and cc-EFTR groups, respectively. Seven (8.4%) patients required surgical treatment (six patients underwent ESD and one underwent cc-EFTR,) due to residual tumor (n=5) and post-procedure adverse events (n=2). Patients undergoing R0 or R1 resection did not experience recurrence during a median 14-month follow-up period, except for one patient in the ESD group.
Conclusions
cc-EFTR displayed a high R0 resection rate; therefore, it is a safe and effective therapeutic option for small gastric GISTs.

Citations

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Advancements in Endoscopic Treatment for Gastric Subepithelial Tumors
Osamu Goto, Kazutoshi Higuchi, Eriko Koizumi, Katsuhiko Iwakiri
Gut and Liver.2025; 19(2): 151. CrossRef
Endoscopic resection penetrating the muscularis propria for gastric gastrointestinal stromal tumors: advances and challenges
Jin Woong Cho
Clinical Endoscopy.2024; 57(3): 329. CrossRef

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Prevalence, natural progression, and clinical practices of upper gastrointestinal subepithelial lesions in Korea: a multicenter study: Younghee Choe, Yu Kyung Cho, Gwang Ha Kim, Jun-Ho Choi, Eun Soo Kim, Ji Hyun Kim, Eun Kwang Choi, Tae Hyeon Kim, Seong-Hun Kim, Do Hoon Kim, The Research Group for Endoscopic Ultrasound in Korean Society of Gastrointestinal Endoscopy; Clin Endosc 2023;56(6):744-753. Published online August 25, 2023; DOI: https://doi.org/10.5946/ce.2023.005

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Background
/Aims: This study aimed to evaluate the prevalence and natural progression of subepithelial lesions (SELs) in the upper gastrointestinal (UGI) tract.
Methods
The medical records of patients with UGI SELs who underwent endoscopic screening at eight university hospitals between January and December 2010 were retrospectively investigated. The follow-up evaluations were performed until December 2016.
Results
UGI SELs were found in 1,044 of the 65,233 participants screened (endoscopic prevalence, 1.60%; the total number of lesions, 1,062; mean age, 55.1±11.2 years; men, 53.6%). The median follow-up period was 48 (range, 8–74) months. SELs were most frequently found in the stomach (63.8%) and had a mean size of 9.9±6.1 mm. Endoscopic ultrasonography (EUS) was performed in 293 patients (28.1%). The most common lesions were leiomyomas, followed by gastrointestinal stromal tumors (GISTs), and ectopic pancreas. The proportions of SELs with malignant potential according to size were 3% (<1 cm), 22% (1–2 cm), 27% (2–3 cm), and 38% (≥3 cm). In gastric SELs larger than 1 cm, resections were performed in 20 patients because of an increase in size, of which 12 were found to be GISTs.
Conclusions
The prevalence of UGI SELs was 1.60%. Further, 23% of gastric SELs ≥1 cm were precancerous lesions, most followed by EUS and clinical decisions without initial pathological confirmation.

Citations

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The efficacy and safety of submucosal tunneling endoscopic resection in treating large esophageal subepithelial lesions
Huiting Lin, Songfeng Chen, Niandi Tan, Qianjun Zhuang, Xingyu Jia, Dianxuan Jiang, Yinglian Xiao, Jinhui Wang
Surgical Endoscopy.2025; 39(3): 1672. CrossRef
Natural Course and Long-Term Outcomes of Gastric Subepithelial Lesions: A Systematic Review
Masaya Iwamuro, Hiroyuki Okada, Motoyuki Otsuka
Journal of Clinical Medicine.2025; 14(4): 1055. CrossRef
Rapidly Growing Gastrointestinal Stromal Tumor on the Esophagus
Ji Hye Park, Sung Eun Kim, Seun Ja Park, Moo In Park, Won Moon, Jae Hyun Kim, Kyoungwon Jung, Myung Hun Lee
The Korean Journal of Helicobacter and Upper Gastrointestinal Research.2025; 25(1): 64. CrossRef
Advancements in Endoscopic Treatment for Gastric Subepithelial Tumors
Osamu Goto, Kazutoshi Higuchi, Eriko Koizumi, Katsuhiko Iwakiri
Gut and Liver.2025; 19(2): 151. CrossRef
Endoscopic mucosal resection of a large duodenal polyp
Ye Rin Chae, Ga Hee Kim
Clinical Endoscopy.2025; 58(2): 331. CrossRef
Diagnostic accuracy and influencing factors of microprobe endoscopic ultrasound for gastrointestinal subepithelial lesions: a multicenter retrospective study
Jiao Li, Yongfeng Yan, Dandan Jiang, Xiaoxiang Wang, Li Wang, Li Liu, Tao Shu, Zhengkui Zhou, Xiaobin Sun
BMC Gastroenterology.2025;[Epub] CrossRef
A Case of Esophageal MALT Lymphoma Mimicking a Subepithelial Tumor
Ha Eun Lee, Gwang Ha Kim, Min Ji Kim, Kyung Bin Kim, Dong Chan Joo, Hye Kyung Jeon, Moon Won Lee, Bong Eun Lee
The Korean Journal of Gastroenterology.2024; 83(4): 157. CrossRef
Small gastric subepithelial lesions: A sand in the eye
Tanyaporn Chantarojanasiri, Nikhil Sonthalia, Rashid N. Lui
Journal of Gastroenterology and Hepatology.2024; 39(7): 1207. CrossRef
Endoscopic treatment of a large Brunner’s gland hamartoma in the duodenum
Ha Eun Lee, Gwang Ha Kim, Kyungbin Kim
Endoscopy.2024; 56(S 01): E546. CrossRef
Artificial Intelligence-Based Diagnosis of Gastric Mesenchymal Tumors Using Digital Endosonography Image Analysis
Dong Chan Joo, Gwang Ha Kim, Moon Won Lee, Bong Eun Lee, Ji Woo Kim, Kwang Baek Kim
Journal of Clinical Medicine.2024; 13(13): 3725. CrossRef
An Esophageal Leiomyoma with Cystic Degeneration Mimicking a Malignant Neoplasm
Gwang Ha Kim, Dong Chan Joo, Moon Won Lee, Bong Eun Lee, Kyungbin Kim
The Ewha Medical Journal.2023;[Epub] CrossRef

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Editorial

Endoscopy under general anesthesia for detecting synchronous lesions of head and neck squamous cell carcinoma: Jin Hee Noh, Do Hoon Kim; Clin Endosc 2023;56(3):308-309. Published online April 28, 2023; DOI: https://doi.org/10.5946/ce.2023.069

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Citations

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Nasopharyngeal examination during transoral upper gastrointestinal endoscopy
Vui Heng Chong
Clinical Endoscopy.2024; 57(1): 137. CrossRef

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110 Download
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Original Articles

Efficacy and safety of intragastric balloon for obesity in Korea: Kwang Gyun Lee, Seung-Joo Nam, Hyuk Soon Choi, Hang Lak Lee, Jai Hoon Yoon, Chan Hyuk Park, Kyoung Oh Kim, Do Hoon Kim, Jung-Wook Kim, Won Sohn, Sung Hoon Jung, Korean Research Group for Endoscopic Management of Metabolic Disorder and Obesity; Clin Endosc 2023;56(3):333-339. Published online December 13, 2022; DOI: https://doi.org/10.5946/ce.2022.143

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Background
/Aims: Intragastric balloon (IGB) is the only available endoscopic bariatric and metabolic therapy in Korea. End-ball (Endalis) has the longest history of clinical use among the IGBs available in Korea. However, little clinical data on this system have been reported. In this study, we aimed to evaluate the efficacy and safety of End-ball in Korea.
Methods
We performed a retrospective cohort study of patients who underwent IGB insertion (End-ball) from 2013 to 2019. Demographic and anthropometric data were collected. The efficacy and safety of IGB treatment were analyzed.
Results
In total, 80 patients were included. Mean age was 33.7 years and 83.8% were female. Initial body mass index was 34.48±4.69 kg/m2. Body mass index reduction was 3.72±2.63 kg/m2 at the time of IGB removal. Percent of total body weight loss (%TBWL) was 10.76%±6.76%. Percentage excess body weight loss was 43.67%±27.59%. Most adverse events were minor, and 71.4% of participants showed nausea, vomiting, or abdominal pain.
Conclusions
IGB treatment showed good efficacy and safety profile in Korean patients with obesity. In terms of %TBWL and percentage excess body weight loss, the efficacy was similar to that in the Western population.

Citations

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Bariatric surgery for treatment of morbid obesity in adults
Ki Bum Park, Kyong-Hwa Jun
The Korean Journal of Internal Medicine.2025; 40(1): 24. CrossRef
Intragastric Balloons
D.T.H. de Moura, Sergio A. Sánchez-Luna, Adriana Fernandes Silva, Alexandre Moraes Bestetti
Gastrointestinal Endoscopy Clinics of North America.2024; 34(4): 687. CrossRef
Effectiveness and Safety of the Allurion Swallowable Intragastric Balloon for Short-term Weight Loss: A Systematic Review and Meta-analysis
Adriana Fernandes Silva, Alexandre Moraes Bestetti, Angelo So Taa Kum, Beanie Conceição Medeiros Nunes, Matheus de Oliveira Veras, Wanderley Marques Bernardo, Eduardo Guimarães Hourneaux de Moura
Obesity Surgery.2024; 34(10): 3735. CrossRef
Endoscopic treatment of obesity: A protocol of updated systematic review with network meta-analysis of randomized controlled trials
Eun Jeong Gong, Chang Seok Bang, Gwang Ho Baik, Dong Keon Yon
PLOS ONE.2024; 19(9): e0308410. CrossRef
How effective is intragastric balloon insertion as an obesity treatment in Korea?
Youngdae Kim
Clinical Endoscopy.2023; 56(3): 310. CrossRef
Laparoscopy-assisted trans-hiatal endoscopic removal of an intragastric balloon after placement-related esophageal perforation
Pablo Cortegoso Valdivia, Giorgio Dalmonte, Marina Valente, Lucia Ballabeni, Federica Gaiani, Gian Luigi de' Angelis, Federico Marchesi
Endoscopy.2023; 55(S 01): E1137. CrossRef

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Outcomes of endoscopic submucosal dissection for superficial esophageal neoplasms in patients with liver cirrhosis: Young Kwon Choi, Jin Hee Noh, Do Hoon Kim, Hee Kyong Na, Ji Yong Ahn, Jeong Hoon Lee, Kee Wook Jung, Kee Don Choi, Ho June Song, Gin Hyug Lee, Hwoon-Yong Jung; Clin Endosc 2022;55(3):381-389. Published online April 20, 2022; DOI: https://doi.org/10.5946/ce.2021.242

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Background
/Aims: The treatment of superficial esophageal neoplasms (SENs) in cirrhotic patients is challenging and rarely investigated. We evaluated the outcomes of endoscopic submucosal dissection (ESD) to determine the efficacy and safety of treating SENs in patients with liver cirrhosis.
Methods
The baseline characteristics and treatment outcomes of patients who underwent ESD for SENs between November 2005 and December 2017 were retrospectively reviewed.
Results
ESD was performed in 437 patients with 481 SENs, including 15 cirrhotic patients with 17 SENs. En bloc resection (88.2% vs. 97.0%) and curative resection (64.7% vs. 78.9%) rates were not different between the cirrhosis and non-cirrhosis groups (p=0.105 and p=0.224, respectively). Bleeding was more common in cirrhotic patients (p=0.054), and all cases were successfully controlled endoscopically. The median procedure and hospitalization duration did not differ between the groups. Overall survival was lower in cirrhotic patients (p=0.003), while disease-specific survival did not differ between the groups (p=0.85).
Conclusions
ESD could be a safe and effective treatment option for SENs in patients with cirrhosis. Detailed preprocedural assessments are needed, including determination of liver function, esophageal varix status, and remaining life expectancy, to identify patients who will obtain the greatest benefit.

Citations

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Endoscopic resection of early esophageal neoplasia in patients with esophageal varices: a systematic review
Charlotte N. Frederiks, Laura S. Boer, Bas Gloudemans, Lorenza Alvarez Herrero, Jacques J.G.H.M. Bergman, Roos E. Pouw, Bas L.A.M. Weusten
Endoscopy.2025; 57(07): 769. CrossRef
Clinical outcomes of endoscopic submucosal dissection for esophageal squamous cell carcinoma with esophageal varices: Multicenter retrospective study
Yosuke Toya, Waku Hatta, Tomohiro Shimada, Tamotsu Matsuhashi, Takeharu Shiroki, Yu Sasaki, Tetsuya Tatsuta, Jun Nakamura, Norihiro Hanabata, Yohei Horikawa, Ko Nagino, Tomoyuki Koike, Atsushi Masamune, Yoshihiro Harada, Tetsuya Ohira, Katsunori Iijima, Y
Digestive Endoscopy.2024; 36(3): 314. CrossRef
Clinical outcomes of endoscopic submucosal dissection for superficial esophageal neoplasia in close proximity to esophageal varices: a multicenter international experience
Shruti Mony, Bing Hu, Abel Joseph, Hiroyuki Aihara, Lorenzo Ferri, Amit Bhatt, Amit Mehta, Peng-Sheng Ting, Alex Chen, Andrew Kalra, Jad Farha, Manabu Onimaru, Long He, Qi Luo, Andrew Y. Wang, Haruhiro Inoue, Saowanee Ngamruengphong
Endoscopy.2024; 56(02): 119. CrossRef
Risk associated with endoscopic treatment of early upper gastrointestinal cancer in patients with liver cirrhosis and management strategies
Yu-Yong Tan, Yu-Min Qing, Jian Gong, De-Liang Liu
World Chinese Journal of Digestology.2024; 32(2): 102. CrossRef
Radical chemoradiotherapy for superficial esophageal cancer complicated with liver cirrhosis
Hejing Bao, Hehong Bao, Liping Lin, Yuhuan Wang, Longbin Zhang, Li Zhang, Han Zhang, Lingxiang Liu, Xiaolong Cao
PeerJ.2024; 12: e18065. CrossRef
Endoscopic management of early esophageal cancer in patients with concomitant cirrhosis
Linlin Zhu, Zhenming Zhang
Chinese Medical Journal.2024; 137(24): 3142. CrossRef
Endoscopic submucosal dissection for early cancers or precancerous lesions of the upper GI tract in cirrhotic patients with esophagogastric varices: 10-year experience from a large tertiary center in China
Shuai Zhang, Ying-Di Liu, Ning-Li Chai, Yi Yao, Fei Gao, Bo Liu, Zhan-Di He, Lu Bai, Xin Huang, Chao Gao, En-Qiang Linghu, Lian-Yong Li
Gastrointestinal Endoscopy.2023; 97(6): 1031. CrossRef
Endoscopic Submucosal Dissection for Treatment of Early-Stage Cancer or Precancerous Lesion in the Upper Gastrointestinal Tract in Patients with Liver Cirrhosis
Yuyong Tan, Yumin Qing, Deliang Liu, Jian Gong
Journal of Clinical Medicine.2023; 12(20): 6509. CrossRef

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Clinical Outcomes of Percutaneous Endoscopic Gastrostomy in the Surgical Intensive Care Unit: Gyu Young Pih, Hee Kyong Na, Suk-Kyung Hong, Ji Yong Ahn, Jeong Hoon Lee, Kee Wook Jung, Do Hoon Kim, Kee Don Choi, Ho June Song, Gin Hyug Lee, Hwoon-Yong Jung; Clin Endosc 2020;53(6):705-716. Published online March 31, 2020; DOI: https://doi.org/10.5946/ce.2019.196

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Background
/Aims: Percutaneous endoscopic gastrostomy (PEG) is usually performed on patients with chronic underlying diseases in the general ward (GW). This study evaluated the clinical outcomes of PEG performed on patients in the surgical intensive care unit (SICU) compared with those of PEG performed in the GW.
Methods
The medical records of 27 patients in the SICU and 263 in the GW, who underwent PEG between January 2013 and July 2017, were retrospectively reviewed.
Results
The median age of the 27 SICU patients was 66 years, and their median body mass index was 21.1 kg/m². In the SICU group, the median baseline Sequential Organ Failure Assessment (SOFA) score was 4, and the median Acute Physiology and Chronic Health Evaluation II (APACHE II) score was 16. The median interval between surgery and PEG in SICU patients was 30 days, with a PEG failure rate of 3.7%. Acute complications in SICU patients included bleeding (7.4%) and ileus (11.1%), while chronic complications included aspiration pneumonia (7.4%) and tube obstruction (3.7%). The rates of acute and chronic complications did not differ significantly between the SICU and GW groups. The 30-day mortality rate was 14.8% in SICU patients and 5.3% in GW patients (p=0.073).
Conclusions
PEG is a safe and feasible method of enteral feeding for critically ill patients who require ICU care after surgery.

Citations

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Endoscopic gastrostomy as a method of enteral nutrition providing
E. A. Drobyazgin, Yu. V. Chikinev, A. V. Korobeynikov, A. S. Polyakevich, I. V. Peshkova, S. G. Stofin
Filin’s Clinical endoscopy.2025; 67(1): 54. CrossRef
Comparative Outcomes of PEG Patients With and Without Hypoxia: Laboratory Findings, Gastric Biopsy Results and Procedural Sedation Practices
Aysegul Torun Goktas, Ali Muhtaroglu, Ersin Kuloglu, Ahmet Cumhur Dulger
Medical Science and Discovery.2025; 12(3): 93. CrossRef
Clinical Practice Guideline for Percutaneous Endoscopic Gastrostomy
Chung Hyun Tae, Ju Yup Lee, Moon Kyung Joo, Chan Hyuk Park, Eun Jeong Gong, Cheol Min Shin, Hyun Lim, Hyuk Soon Choi, Miyoung Choi, Sang Hoon Kim, Chul-Hyun Lim, Jeong-Sik Byeon, Ki-Nam Shim, Geun Am Song, Moon Sung Lee, Jong-Jae Park, Oh Young Lee
Gut and Liver.2024; 18(1): 10. CrossRef
A Multicenter Survey of Percutaneous Endoscopic Gastrostomy in 2019 at Korean Medical Institutions
Jun Woo Park, Tae Gyun Kim, Kwang Bum Cho, Jeong Seok Kim, Jin Woong Cho, Jung Won Jeon, Sun Gyo Lim, Chan Gyoo Kim, Hong Jun Park, Tae Jun Kim, Eun Sun Kim, Su Jin Jeong, Yong Hwan Kwon
Gut and Liver.2024; 18(1): 77. CrossRef
Clinical practice guidelines for percutaneous endoscopic gastrostomy
Chung Hyun Tae, Ju Yup Lee, Moon Kyung Joo, Chan Hyuk Park, Eun Jeong Gong, Cheol Min Shin, Hyun Lim, Hyuk Soon Choi, Miyoung Choi, Sang Hoon Kim, Chul-Hyun Lim, Jeong-Sik Byeon, Ki-Nam Shim, Geun Am Song, Moon Sung Lee, Jong-Jae Park, Oh Young Lee
Clinical Endoscopy.2023; 56(4): 391. CrossRef
Risk factors and natural history of bedside percutaneous endoscopic versus fluoroscopy-guided gastrostomy tubes in intensive care unit patients
Lucy Ching Chau, Ryan Soheim, Michael Dix, Sarah Chung, Nadia Obeid, Arielle Hodari-Gupta, Cletus Stanton
Surgical Endoscopy.2023; 37(11): 8742. CrossRef
Clinical Practice Guideline for Percutaneous Endoscopic Gastrostomy
Chung Hyun Tae, Ju Yup Lee, Moon Kyung Joo, Chan Hyuk Park, Eun Jeong Gong, Cheol Min Shin, Hyun Lim, Hyuk Soon Choi, Miyoung Choi, Sang Hoon Kim, Chul-Hyun Lim, Jeong-Sik Byeon, Ki-Nam Shim, Geun Am Song, Moon Sung Lee, Jong-Jae Park, Oh Young Lee
The Korean Journal of Gastroenterology.2023; 82(3): 107. CrossRef
Relative contraindications to percutaneous endoscopic gastrostomy (review of literature)
Yu. O. Zharikov, M. Kh. Gurtsiev, S. Zh. Antonyan, S. F. Askerova, E. I. Chairkina, P. A. Yartsev
Grekov's Bulletin of Surgery.2022; 180(6): 105. CrossRef

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Focused Review Series: Application of Artificial Intelligence in GI Endoscopy

Convolutional Neural Network Technology in Endoscopic Imaging: Artificial Intelligence for Endoscopy: Joonmyeong Choi, Keewon Shin, Jinhoon Jung, Hyun-Jin Bae, Do Hoon Kim, Jeong-Sik Byeon, Namku Kim; Clin Endosc 2020;53(2):117-126. Published online March 30, 2020; DOI: https://doi.org/10.5946/ce.2020.054

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Recently, significant improvements have been made in artificial intelligence. The artificial neural network was introduced in the 1950s. However, because of the low computing power and insufficient datasets available at that time, artificial neural networks suffered from overfitting and vanishing gradient problems for training deep networks. This concept has become more promising owing to the enhanced big data processing capability, improvement in computing power with parallel processing units, and new algorithms for deep neural networks, which are becoming increasingly successful and attracting interest in many domains, including computer vision, speech recognition, and natural language processing. Recent studies in this technology augur well for medical and healthcare applications, especially in endoscopic imaging. This paper provides perspectives on the history, development, applications, and challenges of deep-learning technology.

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Focused Review Series: Recent Update of Endoscopic Ultrasonography in Gastrointestinal Subepithelial Tumors

Endoscopic Ultrasound-Guided Fine Needle Aspiration and Biopsy in Gastrointestinal Subepithelial Tumors: Gyu Young Pih, Do Hoon Kim; Clin Endosc 2019;52(4):314-320. Published online July 30, 2019; DOI: https://doi.org/10.5946/ce.2019.100

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The incidence of asymptomatic and incidentally found upper gastrointestinal subepithelial tumors (SETs) is increasing with the implementation of national cancer screening and the development of high-resolution endoscopy in Korea. However, endoscopy alone cannot be used to determine whether SETs are benign or malignant. Endoscopic ultrasound (EUS) is used to further characterize these lesions through the examination of their layered structure, internal echogenicity, size, and relationship to the extramural structure. These provide additional information on whether the lesion is benign or malignant. Nevertheless, the sensitivity and specificity of EUS alone in predicting malignancy is unsatisfactory. Recent guidelines have recommended deciding the timing of EUS-fine needle aspiration and biopsy (EUS-FNA/B) for SETs based on tumor size, malignant features on endoscopy, and high-risk features on EUS. The diagnostic accuracy of EUS-FNA/B is reportedly influenced by factors including needle size, number of needle passes, use of suction, use of a stylet in the needle assembly, fanning technique, availability of an on-site cytopathologist, and experience of the endosonographer. Therefore, according to the characteristics of the SETs, various subsequent methods and techniques should be appropriately employed to improve the diagnostic yield of EUS-FNA/B.

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Focused Review Series: Updates on endoscopic bariatric and metabolic therapies

Small Bowel Endoscopic Bariatric Therapies: Eun Jeong Gong, Do Hoon Kim; Clin Endosc 2018;51(5):425-429. Published online September 27, 2018; DOI: https://doi.org/10.5946/ce.2018.153

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Endoscopic bariatric therapies that emulate some of the principles of bariatric surgery have been developed as a less invasive option for the treatment of obesity and related comorbidities. Small bowel endoscopic bariatric therapies include bypass sleeves, incisionless anastomosis systems, and duodenal mucosal resurfacing. Clinical experience with small bowel devices suggests that endoscopic bariatric procedures can be safely implemented and that these devices are effective for both weight loss and metabolic improvement. Although the mechanisms behind these effects should be further elucidated, endoscopic bariatric therapies may be more effective and safer adjunctive interventions than lifestyle modifications and pharmacological regimens for patients with obesity or obesity-related comorbidities.

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Original Article

Long-Term Survival and Tumor Recurrence in Patients with Superficial Esophageal Cancer after Complete Non-Curative Endoscopic Resection: A Single-Center Case Series: Ji Wan Lee, Charles J. Cho, Do Hoon Kim, Ji Yong Ahn, Jeong Hoon Lee, Kee Don Choi, Ho June Song, Sook Ryun Park, Hyun Joo Lee, Yong Hee Kim, Gin Hyug Lee, Hwoon-Yong Jung, Sung-Bae Kim, Jong Hoon Kim, Seung-Il Park; Clin Endosc 2018;51(5):470-477. Published online June 1, 2018; DOI: https://doi.org/10.5946/ce.2018.025

Abstract PDF PubReader ePub

Background
/Aims: To report the long-term survival and tumor recurrence outcomes in patients with superficial esophageal cancer (SEC) after complete non-curative endoscopic resection (ER).
Methods
We retrieved ER data for 24 patients with non-curatively resected SEC. Non-curative resection was defined as the presence of submucosal and/or lymphovascular invasion on ER pathology. Relevant clinical and tumor-specific parameters were reviewed.
Results
The mean age of the 24 study patients was 66.3±8.3 years. Ten patients were closely followed up without treatment, while 14 received additional treatment. During a mean follow-up of 59.0±33.2 months, the 3- and 5-year survival rates of all cases were 90.7% and 77.6%, respectively. The 5-year overall survival rates were 72.9% in the close observation group and 82.1% in the additional treatment group (p=0.958). The 5-year cumulative incidences of all cases of recurrence (25.0% vs. 43.3%, p=0.388), primary EC recurrence (10.0% vs. 16.4%, p=0.558), and metachronous EC recurrence (16.7% vs. 26.7%, p=0.667) were similar between the two groups.
Conclusions
Patients with non-curatively resected SEC showed good long-term survival outcomes. Given the similar oncologic outcomes, close observation may be an option with appropriate caution taken for patients who are medically unfit to receive additional therapy.

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Byeong Geun Song, Ga Hee Kim, Charles J. Cho, Hyeong Ryul Kim, Yang Won Min, Hyuk Lee, Byung-Hoon Min, Ho June Song, Yong-Hee Kim, Jun Haeng Lee, Hwoon-Yong Jung, Jae Ill Zo, Young Mog Shim
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Non-Curative Endoscopic Resection for Superficial Esophageal Cancer
Eun Hye Kim, Jun Chul Park
Clinical Endoscopy.2018; 51(5): 399. CrossRef

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Commentary

Retention Esophagitis in Patients with Achalasia Requires Cancer Surveillance: Eun Jeong Gong, Do Hoon Kim; Clin Endosc 2018;51(2):111-112. Published online March 20, 2018; DOI: https://doi.org/10.5946/ce.2018.037

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Review

Endoscopic Ultrasonography in the Diagnosis of Gastric Subepithelial Lesions: Eun Jeong Gong, Do Hoon Kim; Clin Endosc 2016;49(5):425-433. Published online September 5, 2016; DOI: https://doi.org/10.5946/ce.2016.065

Abstract PDF PubReader ePub

Subepithelial lesions occasionally found in the stomach of patients undergoing endoscopy may be either benign lesions or tumors with malignant potential. They may also appear due to extrinsic compression. Discrimination of gastric subepithelial lesions begins with meticulous endoscopic examination for size, shape, color, mobility, consistency, and appearance of the overlying mucosa. Accurate diagnosis can be achieved with endoscopic ultrasonography, which provides useful information on the exact size, layer-of-origin, and characteristic morphologic features to support a definitive diagnosis. Endoscopic ultrasonography also aids in the prediction of malignant potential, especially in gastrointestinal stromal tumors. Features of subepithelial lesions identified on endoscopic ultrasonography can be used to determine whether further diagnostic procedures such as endoscopic resection, fine needle aspiration, or core biopsy are required. Endoscopic ultrasonography is a valuable tool for diagnosis and clinical decision making during follow-up of gastric subepithelial lesions.

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Original Article

Characteristics of Missed Simultaneous Gastric Lesions Based on Double-Check Analysis of the Endoscopic Image: Eun Jeong Gong, Jeong Hoon Lee, Kyoungwon Jung, Charles J. Cho, Hee Kyong Na, Ji Yong Ahn, Kee Wook Jung, Do Hoon Kim, Kee Don Choi, Ho June Song, Gin Hyug Lee, Hwoon-Yong Jung, Jin-Ho Kim; Clin Endosc 2017;50(3):261-269. Published online August 22, 2016; DOI: https://doi.org/10.5946/ce.2016.056

Abstract PDF PubReader ePub

Background
/Aims: The detection of multifocal lesions is important for the successful management of gastric neoplasms. We investigated the characteristics of missed simultaneous lesions and the reason for the missed diagnoses.
Methods
A total of 140 patients who underwent repeat endoscopy before endoscopic resection between June 2013 and June 2014 were retrospectively reviewed. We classified simultaneous lesions into three groups based on a review of earlier images: group 1, no images of the location of simultaneous lesions were taken; group 2, no corresponding lesion was evident in the previous images; and group 3, simultaneous lesions were visible in the earlier images but a biopsy was not performed.
Results
Simultaneous lesions were found in 12 patients (8.6%) with 13 lesions, comprising 10 dysplasia (76.9%) and three adenocarcinoma (23.1%). Regarding the reasons for missed diagnoses, seven lesions (53.8%) were classified as group 3, five (38.5%) as group 1, and the remaining lesion (7.7%) as group 2. There were no significant differences in the characteristics of the patients with and without simultaneous lesions.
Conclusions
Lesions disregarded or unnoticed during endoscopic examination were the main reason for missed diagnosis of simultaneous lesions. Endoscopists should consider the possibility of simultaneous lesions and attempt to meticulously evaluate the entire gastric mucosa.

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Case Report

Superficial Esophageal Neoplasms Overlying Leiomyomas Removed by Endoscopic Submucosal Dissection: Case Reports and Review of the Literature: Myeongsook Seo, Do Hoon Kim, Young-Whan Cho, Eun Jeong Gong, Sunpyo Lee, Eunji Choi, Hwoon-Yong Jung, Jin-Ho Kim; Clin Endosc 2015;48(4):322-327. Published online July 24, 2015; DOI: https://doi.org/10.5946/ce.2015.48.4.322

Abstract PDF PubReader ePub

The coexistence of an epithelial lesion and a subepithelial lesion is uncommon. In almost all such cases, the coexistence of these lesions appears to be incidental. It is also extremely rare to encounter a neoplasm in the surface epithelium that overlies a benign mesenchymal tumor in the esophagus. Several cases of a coexisting esophageal neoplasm overlying a leiomyoma that is treated endoscopically or surgically have been reported previously. Here, three cases of a superficial esophageal neoplasm that developed over an esophageal leiomyoma and was then successfully removed by endoscopic submucosal dissection are described.

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Original Articles

Yields and Utility of Endoscopic Ultrasonography-Guided 19-Gauge Trucut Biopsy versus 22-Gauge Fine Needle Aspiration for Diagnosing Gastric Subepithelial Tumors: Hee Kyong Na, Jeong Hoon Lee, Young Soo Park, Ji Yong Ahn, Kwi-Sook Choi, Do Hoon Kim, Kee Don Choi, Ho June Song, Gin Hyug Lee, Hwoon-Yong Jung, Jin-Ho Kim; Clin Endosc 2015;48(2):152-157. Published online March 27, 2015; DOI: https://doi.org/10.5946/ce.2015.48.2.152

Abstract PDF PubReader ePub

Background/Aims

To evaluate the yields and utility of 19-gauge (G) Trucut biopsy (TCB) versus 22 G fine needle aspiration (FNA) for diagnosing gastric subepithelial tumors (SETs).

Methods

We retrieved data for 152 patients with a gastric SET larger than 2 cm who had undergone endoscopic ultrasonography (EUS)-guided 19 G TCB (n=90) or 22 G FNA (n=62). Relevant clinical, tumor-specific, and EUS procedural information was reviewed retrospectively.

Results

A specific diagnosis was made for 76 gastrointestinal stromal tumors (GISTs) and 51 non-GIST SETs. The diagnostic yield of TCB was greater than that of FNA (77.8% vs. 38.7%, p<0.001). The percentage of non-diagnostic specimens (suspicious and insufficient) was significantly lower in the TCB group (6.7% and 15.5%, respectively) than in the FNA group (22.6% and 38.7%, respectively; both p<0.001). TCB accurately diagnosed 90.9% of GISTs and 81.1% of non-GIST SETs, whereas FNA accurately diagnosed 68.8% of GISTs and 14.3% of non-GIST SETs. There were nine technical failures with TCB, and the rate of adverse events did not differ between the groups (TCB vs. FNA, 3.3% vs. 8.1%; p=0.27).

Conclusions

Nineteen-gauge TCB is safe and highly valuable for diagnosing gastric SETs larger than 2 cm if technical failure can be avoided.

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Comparison of Clinical Outcomes Associated with Pull-Type and Introducer-Type Percutaneous Endoscopic Gastrostomies: Sin Won Lee, Jeong Hoon Lee, Hyungjin Cho, Yeonjung Ha, Hyun Lim, Ji Yong Ahn, Kwi Sook Choi, Do Hoon Kim, Kee Don Choi, Ho June Song, Gin Hyug Lee, Hwoon-Yong Jung, Jin-Ho Kim; Clin Endosc 2014;47(6):530-537. Published online November 30, 2014; DOI: https://doi.org/10.5946/ce.2014.47.6.530

Abstract PDF PubReader ePub

Background/Aims

Percutaneous endoscopic gastrostomy (PEG) is a method of providing enteral nutrition using endoscopy. The PEG techniques differ according to the insertion method, and include the pull type, push type, and introducer type. The aim of this study was to compare the clinical outcomes associated with the pull-type and introducer-type PEG insertion techniques, which included the adverse events, at our tertiary care center in Korea.

Methods

We retrospectively reviewed 141 cases that had undergone PEG insertion at our center from January 2009 to June 2012. The indications for PEG insertion and the acute and chronic complications caused by each type of PEG insertion were analyzed.

Results

The indications for PEG insertion in our cohort included neurologic disease (58.7%), malignancy (21.7%), and other indications (19.6%). Successful PEG insertions were performed on 136 cases (96.5%), and there were no PEG-associated deaths. Bleeding was the most frequent acute complication (12.8%), and wound problems were the most frequent chronic complications (8.8%). There were no statistically significant differences between the pull-type and introducer-type PEG insertion techniques in relation to complication rates in our study population.

Conclusions

PEG insertion is considered a safe procedure. The pull-type and introducer-type PEG insertion techniques produce comparable outcomes, and physicians may choose either of these approaches according to the circumstances.

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Case Report

Intralesional Steroid Injection to Prevent Stricture after Near-Circumferential Endosopic Submucosal Dissection for Superficial Esophageal Cancer: Wook Jin Lee, Hwoon-Yong Jung, Do Hoon Kim, Jeong Hoon Lee, Kee Don Choi, Ho June Song, Gin Hyug Lee, Jin-Ho Kim; Clin Endosc 2013;46(6):643-646. Published online November 19, 2013; DOI: https://doi.org/10.5946/ce.2013.46.6.643

Abstract PDF PubReader ePub

Stricture frequently occurs after endoscopic submucosal dissection (ESD) for superficial esophageal carcinoma with near- or whole-circumferential mucosal defects, and post-ESD stricture is difficult to treat and usually requires multiple sessions of endoscopic balloon dilatation. Intralesional steroid injection has previously been used to prevent stricture; however, there have been few experiences with this method after near- or whole-circumferential ESD. We present a case of a single session of intralesional steroid injection performed immediately after near-circumferential ESD to prevent post-ESD stricture. After a follow-up period of 6 months, the patient showed good outcome without dysphagia.

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